
<div id="_page" style="margin: 0px auto; background: rgb(255, 255, 255); width: 210mm; min-height: 297mm; transform: scale(1, 1); transform-origin: 50% 0px 0px;" pagekind="A4" direct="portrait">
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		<label style=" font-family: 宋体; font-size: 15.75pt; font-weight: bold; text-align: Center;">云南城投昆明妇女儿童医院</label>
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		<label style=" font-family: 宋体; font-size: 15.75pt; font-weight: bold;">麻醉知情同意书</label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">姓名:</label>
		<field tabindex="0" id="姓名" name="姓名" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="姓名">姓名</field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;"> 性别:</label>
		<field tabindex="0" id="性别" name="性别" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="性别">性别</field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;"> 年龄:</label>
		<field tabindex="0" id="年龄" name="年龄" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="年龄">年龄</field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;"> 门诊号:</label>
<field tabindex="0" id="病历号" name="病历号" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="病历号" data-code="" validate="false" format="">病历号</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;">科室:</label>
<field tabindex="0" id="科室" name="科室" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="{科室}">科室</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;"> 床号:</label>
		<field tabindex="0" id="日期" name="日期" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="床号">床号</field>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">诊断:</label>
<field tabindex="0" id="诊断" name="诊断" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="诊断" data-code="" validate="false" format="">诊断</field>&nbsp;<label style=" font-family: 仿宋; font-size: 14.25pt;">执行检查手术: </label>
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="执行手术">执行手术</field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;"> 体重: </label>
		<field tabindex="0" id="体重" name="体重" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title="体重" data-code="" validate="false" format="alpha">{体重}</field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">k</label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">任何麻醉均有风险性，在根据患者病情，切实做好麻醉前准备并按操作规范认真做好麻醉工 作及范防范措施情况下，仍有可能发生以下难以避免的麻醉意外及并发症：</label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">1、根据麻醉需要及操作规范，遵照《中华人民共和国药典》要求使用各种麻醉药物和输液用液体 后，由于患者体制原因，出现输液反应，过敏、高敏反应，致热源反应等，甚至导致过敏性休 克、呼吸心跳停止； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">2、麻醉期间可能发生恶心、呕吐、返流误吸、喉水肿、喉痉挛，导致气道梗阻，窒息；</label>
		<label style=" font-family: 宋体; font-size: 14.25pt;"> </label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">3、呼吸抑制甚至短暂呼吸暂停；血压下降；心率减慢；严重者可能发生心跳呼吸骤停； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">4、因麻醉诱发原有隐患匿性疾病发作，如哮喘、癫痫、心脑血管意外等； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">5、因抢救需要气管插管，可能损伤患者口唇、牙齿、引起反流误吸、气道痉挛、窒息； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">6、其他难以预料的并发症及意外。 </label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">麻醉后注意事项 </label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">1、麻醉结束后2小时内不要饮水、进食； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">2、接受麻醉后当天，不能驾驶机动车，骑自行车及电动车，不能经行精细操作工作和高空作业； </label>
	</p><p style=" font-family: 宋体; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">3、麻醉结束后，请在医院观察休息一段时间，待麻醉医生认可后，方能离开； </label>
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		<label style=" font-family: 仿宋; font-size: 14.25pt;">我们将以良好的医德医术为患者实行麻醉，力争将麻醉风险降低到最低程度，保障患者安全。上 述情况以对患者及家属说明，并对患者方提出的问题作了详细的解答，经慎重考虑，患者及家属 对麻醉可能出现的风险表示充分的理解，同意要求实行麻醉，签字为证：</label>
	</p><p style="undefined" id="" title="患者签名">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">患者本人签字</label><img type="sign" alt="双击手写签名" style="width: 120px; height: 40px;" draggable="false" id="patient-sign" name="patient-sign" title=""><span style="font-size: 14.25pt;"> 签字时间_____年___月___日___ 时____分 </span></p><p style=" font-family: 仿宋; font-size: 14.25pt;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">患者家属签字</label><img type="sign" alt="双击手写签名" style="width: 120px; height: 40px;" draggable="false" id="patient-family-sign" name="patient-family-sign" title="家属签名"><span style="font-size: 14.25pt;">与患者关系_____</span></p><p style=" font-family: 仿宋; font-size: 14.25pt; text-align: Center;"><br></p><p style=" font-family: 宋体; font-size: 12pt; text-align: Right;">
		<label style=" font-family: 仿宋; font-size: 14.25pt;">麻醉医师签名： <img readonly style="width: 120px; height: 80px;" type="sign" alt="医生签名"  id="doctor-sign" name="doctor-sign" title="医生签名">      </label>
	</p><p style=" font-family: 宋体; font-size: 12pt; text-align: Right;">
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">年</label>
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">月</label>
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">日</label>
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">时</label>
		<field tabindex="0" class="blank" style=" font-family: 仿宋; font-size: 14.25pt;" contenteditable="true" type="Text" value="" title=""></field>
		<label style=" font-family: 仿宋; font-size: 14.25pt;">分</label>
		<label style=" font-family: 仿宋; font-size: 14.25pt; text-align: Right;"> </label>
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